WASHINGTON — Republicans are intent on repealing a public health fund created by the Affordable Care Act — but with President Trump also pursuing a dramatic reduction in domestic spending, lawmakers admit they don’t know if they could make up the losses at one of the nation’s most critical health agencies.

The latest version of the GOP health care bill would end the law’s Prevention and Public Health Fund, which provides nearly $1 billion annually, in 2019. Those dollars have become an integral part of the Centers for Disease Control and Prevention’s budget, accounting for one-eighth of its funding and providing more than $300 million for immunizations alone.

Assuming the fund is repealed, the CDC would have a big hole to fill. But Trump has also signaled he wants to boost defense spending and reduce spending for domestic programs by the same amount, potentially more than $50 billion.

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Congressman Tom Cole, a Republican who leads a key panel that oversees CDC’s budget, said it was “too early to tell” what would happen or whether his party could do anything to make the agency’s funding whole. He was waiting for more specific direction from the administration.

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“Until we actually get a top-line number, we’re not in a position to rule anything in or out,” he told STAT last week.

But he later acknowledged that, given the scope of the cuts being considered, almost every agency would likely be affected. “If that happened, everybody is going to be impacted.”

The Oklahoma congressman warned of the consequences of deep cuts to CDC, even if he is at the same time supportive of increased defense spending.

“What CDC does is probably more important to the average American than, in a sense, the Defense Department,” he said. “You’re much more likely to be killed in a pandemic than you are in a terrorist attack, so you need to look at it that way. Those investments are extraordinarily important for the protection of the country.”

The prevention fund, created in 2010 by the ACA, provided $932 million for public health programs in 2016.

The CDC received almost all of it, $891 million, or 12 percent of its overall budget. The funds included $324 million for immunization programs, $160 million in block grants for preventive health services, and $126 million for awareness programs focused on the harms of tobacco use.

Nonetheless, other Republicans are happy to get rid of the prevention fund, long a target of their criticism. Whether the latest version of the health care bill sees more changes or becomes law as written, the fund seems beyond saving.

“Look, it’s a slush fund,” said Congressman Andy Harris of Maryland, a Republican physician who sits on the House appropriations health subcommittee. “It’s been used by the secretary [of health and human services] for whatever the secretary wants. It’s a misnomer to call it the Prevention and Public Health Fund, because it’s been used for other things, and it’s about time we eliminated it.”

“You’re much more likely to be killed in a pandemic than you are in a terrorist attack, so you need to look at it that way.”

Representative Tom Cole

Like Cole, Harris left open the possibility of filling the funding gap, though at the same time, he suggested states — which are often the recipients of the CDC’s grants — might need to pick up some of the slack.

“If you want to put money into the CDC or somewhere else, put it into the CDC or somewhere else,” Harris said. “At some point, we have to say that it’s not unreasonable to turn over some of these costs to the states, because they’re not running a deficit, and we are.”

A CDC spokesperson declined to comment, saying the agency cannot speculate about the impact of repealing the fund until it has a budget.

The vast majority of the health care debate so far has focused on health insurance, which has led public health groups to sound the alarm.

The Association of State and Territorial Health Officials sent a letter to congressional leadership in January warning of the consequences for its repeal. The Trust for America’s Health followed up with its own statement after Politico published an early version of the legislation that confirmed fears about the fund’s elimination.

“We were concerned that core public health funding — the PPHF and other good public health elements in the ACA — might get thrown out, a baby with the bathwater kind of thing,” said ASTHO’s executive director, Mike Fraser. “There’s so much more to ACA than just health insurance.”

ASTHO leaders had already planned a lobbying trip to Washington for early March, and now will spend two days in the capital this week urging Congress to make up for lost health care funding either through a long-shot effort to preserve the fund or smaller measures to make up for individual items that are cut.

Other public health advocates worry that the prevention fund cuts are the tip of the iceberg, and that agency budgets beyond just prevention fund dollars are also at risk.

“Until somebody tells us otherwise,” said Richard Hamburg, an executive vice president at TFAH, “if close to $1 billion per year [in prevention fund money] is threatened and we’re hearing that the defense discretionary budget may be an increase of 10 percent, one would have to assume there’d be some across-the-board-cuts in other agencies.”

Hmmmm, have we never seen taxpayer money wasted, “lost”, frittered away? Where’s the billion Obama gave them for Zika? According to the CDC, a rather harmless little virus, similar to a cold in the US that had a correlation with microencephaly…in a population that was very poor, and had many contacts with pesticides and other agricultural chemicals, as well as other risk factors. They haven’t come up with this correlation anywhere else, even in neighboring Columbia. Correlation is not necessarily causation. Having friends who grew up in Brazil, who all had Zika and knew of no cases of microencephaly was the first clue. This is the reality of being a government agency, dependent on taxpayer money. The folly is in thinking that only the government agencies can be effective, when so much of the foundation of modern science was funded privately.

“The CDC received . . . $126 million for awareness programs focused on the harms of tobacco use.”

Eliminating this funding would greatly benefit public health (and save taxpayers lots of money) because Obama’s CDC Director Tom Frieden spent much of those funds deceiving the public about, and lobbying to ban the sale and use of lifesaving vapor products to/by 5 million adult smokers who vape and to/by 2.5 million vapers who already quit smoking (according to CDC’s 2015 NHIS data).

During the past 8 years, CDC has done very little to reduce cigarette smoking. Instead, the CDC focused its tobacco control efforts (and wasted a lot of taxpayer money) to manufacture public panics about the negligible risks of nicotine (which is similar to caffeine), vapor products and smokeless tobacco products (which are 99% less harmful than cigarette smoking, and have helped millions of smokers quit), cigars (which are about 90% less harmful than cigarettes), hookah (which is a college fad that has created no known daily hookah smokers), and flavorings in tobacco and vapor products (which CDC wants to ban).

Since 2009 (when Obama’s FDA appointees unlawfully banned vapor products, and when US Customs Agents seized nearly 1,000 shipments of e-cigarettes at US Ports), Obama’s CDC has falsely claimed that e-cigarettes are target marketed to children, are addicting “an entire generation of youth” to nicotine, are gateways to cigarette smoking, are renormalizing cigarette smoking, do NOT help smokers quit smoking, and may be as harmful as cigarette smoking. All of those claims are as false today as they were in 2009, but CDC, FDA, NIDA, and recently SG Murthy continue to repeat those same falsely fear mongering claims over and over and over again, while CDC has given hundreds of millions of dollars to state and local health agencies, to ANR and many other vaping prohibitionists to repeat those false claims to lobby for FDA’s vapor ban and state/local vaping bans.

All of those actions by CDC protect cigarettes, and threaten the lives of addicted cigarette smokers and vapers who have already quit smoking by switching to vapor.

Since none of the facts and evidence about vaping (and our many communications) changed CDC’s anti vaping (and anti tobacco harm reduction) propaganda and lobbying campaigns, perhaps the best way to end CDC public health malpractice is to reduce its budget.

The new version of the ACA: defund any abortion care, get rid of the CDC no more vaccines. Just for starters. Can’t you people stop this? (I’m a Canadian). I don’t want your people to suffer from this mismanagement, and I haven’t read it all. I can say that I don’t want mosquitoes to fly from your country to mine.